难治性鼻-鼻窦炎综合治疗的疗效观察

Efficacy of combined modality therapy for intractable difficult-to-treat rhinosinusitis

目的:探讨难治性鼻-鼻窦炎综合治疗的临床效果。方法:回顾性分析42例难治性鼻-鼻窦炎患者的临床资料,所有患者实施修正性鼻内镜手术和系统化、个性化的综合治疗,分别于术后6个月和12个月对临床疗效进行评估。结果:42例患者完成术后6个月随访,35例患者完成术后12个月随访。与术前比较,患者的视觉模拟量表(VAS)评分和Lund-Kennedy评分在术后6个月和12个月都有显著降低,差异有统计学意义(均P<0.01);术后12个月的VAS评分和Lund-Kennedy评分与术后6个月比较,差异无统计学意义(均P>0.05)。术后6个月42例患者病情完全控制16例(38.1%),部分控制19例(45.2%),未控制7例(16.7%);术后12个月35例患者病情完全控制11例(31.4%),部分控制15例(42.9%),未控制9例(25.7%)。术后6个月和12个月的治疗总有效率分别为83.3%、74.3%,差异无统计学意义(χ2=1.019,P>0.05)。结论:以合理的修正性鼻内镜手术为基础,实施系统化、个性化的综合治疗,难治性鼻-鼻窦炎的疗效满意且稳定,值得临床推广应用。

Objective：To investigate the clinical effects of the combined modality therapy for the patients with difficult-to-treat rhinosinusitis（DTRS）.Method：The clinical data involving 42 patients with DTRS were analyzed retrospectively.All patients received revision endoscopic sinus surgery（ESS）and combined modality therapy systematically and individually.The clinical effects of all patients were observed 6-and 12-month following revision ESS.Result：Forty-two patients were followed up for 6months,whereas 35 patients were followed for 12 months post operation.VAS scores of the patients significantly improved（P〈0.01）6-and 12-month after revision ESS,but there was no statistic difference（P0.05）between 6-and 12-month post operation.Moreover,LundKennedy scores by endoscopy significantly improved（P0.01）6-and 12-month following ESS.Similarly,there was no statistic difference（P〉0.05）between 6-and 12-month postoperatively.Additionally,within 6 months follow-up,16 of 42patients（38.1%）were cured,19 of 42patients（45.2%）were improved,and 7of 42patients（16.7%）were ineffective.The total effective rate in all patients was 83.3% 6 months postoperatively.While within 12 months follow-up,11 of 35patients（31.4%）were cured,15 of 35patients（42.9%）were improved,and 9of 35patients（25.7%）were ineffective.Hence,the total effective rate in 35 patients was 74.3% after 12-month follow-up.There was no statistic difference（χ^2=1.019,P0.05）between 6-and 12-month postoperatively.Conclusion：Appropriate revision ESS plus the combined modality therapy has been proven to be an effective method for the treatment of DTRS.The clinical effects in this study are significant and stable,and thus it is worthy of further clinical applications.